Background Presentation

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CCOHS Forum 2005 New Strategies for Recognizing
and Preventing Occupational Diseases 3-4 March
2005, Toronto, Canada

• Background Presentation
• on the ILO List of Occupational Diseases

Shengli Niu, MD, MPH, MSc Senior Specialist on
Occupational Health International Labour
Office Geneva, Switzerland
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Occupational Risk Factors

• Chemical risk factors 100,000 (Carcinogens400)
• Biological agents 200
• Physical factors 50
• Adverse ergonomic conditions 20
• Allergens 3000

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Occupational injuries and diseases

• 250 million accidents
• 160 million occupational diseases
• 4 of worlds gross national product is lost
• Source Kofi A. Annan. Occupational health and
  safety a high priority on the global,
  international and national agenda. Asian-Pacific
  Newslett on OSH 1997459

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Deaths, Disabilities and Diseases

• ILO Estimate of work related deaths in 2000
• 1.9 2.3 Million

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Work-related Annual Deaths - World

• Economically active population 2.7 billion
• Deaths attributed to occupation 1.9 - 2.3
  Million
• Work-related diseases(lower limit) 1.6
  Million
• - communicable diseases, w/r 320 000
• - cancer, w/r 610 000
• - circulatory diseases, w/r 449 000
• - chronic respiratory diseases
  (silicosis 36 000), w/r 145 000
• - nervous system disorders, w/r 20 000
• - digestive system diseases, w/r 21 000
• - genito-urinary disorders, w/r 9 000
• Deaths caused by work accidents 355
  000
• Commuting injuries
• (not included in overall deaths above) 158 000

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Magnitude of Safety and HealthProblems at Work

• ILO estimates that 4 of the world Gross Domestic
  Product is lost due to accidents and work-related
  diseases.

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Economic Aspects of Work-Related Safety and
Health Problems
Global Economic Losses and GDPs of Selected
Countries ( in billion US)
World GDP 36356 billion US Dollars in 2003
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Costs of work-related injuries and diseases
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POISONING CAUSED BY N-HEXANE
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TRICHLOROETHYLENE POISONING ALLERGIC REACTION
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BENZENE POISONING
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PNEUMOCONIOSIS
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Occupational Diseases

• Diseases caused by work have to be discovered
  and their victims be properly compensated.

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Occupational Diseases

• Definition of occupational diseases is usually
  set out in legislation.
• Impacts of identification of occupational
  diseases compensation and national and
  enterprise level preventive programmes.

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Determination of Occupational Diseases

• Causality between the disease and the exposure
  factor (physical, chemical, biological and
  others) at work.
• The relationship between exposure and the
  severity of the impairment among workers
• The number of workers exposed

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ILO Response

• The International Labour Organization was founded
  in 1919 to ensure everyone the right to earn a
  living in freedom, dignity and security, in
  short, the right to decent work.
• We have never accepted the belief that injury and
  disease "go with the job

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ILO Mandate

• The protection of the worker against sickness,
  disease and injury arising out of employment is
  one of the tasks assigned to the ILO in the words
  of the Preamble of its Constitution.

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International Labour Organization

• A tripartite organization
• Standard-setting
• Conventions Recommendations

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Historical development in identification of
occupational diseases

• In 1919
• R. 3 Anthrax Prevention
• R.4. Lead Poisoning (Women and children)

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History and development

• In 1925 C. 18 Workmens Compensation
  (occupational diseases)
• Poisoning by lead, its alloys or compounds and
  their sequelae,
• Poisoning by mercury, its amalgams and compounds
  and their sequelae and
• Anthrax infection.

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History and development
In 1934 C. 42 Revised C.18

• lead poisoning
• mercury poisoning,
• anthrax
• silicosis
• phosphorus poisoning
• arsenic poisoning
• poisoning by benzene

• poisoning by the halogen derivatives of
  hydrocarbons of the aliphatic series
• diseases due to radiation, and
• skin cancer (primary epitheliomatous cancer of
  the skin)

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History and development

• 1964, C.121 R.121 Employment Injury Benefits
• Definition of occupational diseases
• Amendment of the list of occupational diseases
• List of occupational diseases

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History and development

• 1. Definition of occupational diseases
• Paragraph 6(1) of Recommendation No. 121 defines
  occupational diseases as follows
•   Each Member should, under prescribed
  conditions, regard diseases known to arise out of
  the exposure to substances and dangerous
  conditions in process, trades or occupations as
  occupational diseases. 

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Definition of occupational diseases

• Paragraph 7 of the recommendation No. 121 states
• Where national legislation contains a list
  establishing a presumption of occupational origin
  in respect of certain diseases, proof should be
  permitted of the occupational origin of diseases
  not so listed and of diseases listed when they
  manifest themselves under conditions different
  from those establishing a presumption of their
  occupational origin.

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Two Main Elements in the Definition

• The exposure-effect relationship between a
  specific working environment and/or activity and
  a specific disease effect
• The fact that these diseases occur among the
  group of persons concerned with a frequency above
  the average morbidity of the rest of the
  population

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List of Occupational Diseases

• Convention No. 121 is appended with a separate
  schedule which allows for amending the schedule
  without having to adopt a new Convention.
• This separate schedule contains a list of
  occupational diseases giving entitlement to
  benefit.
• Under article 8 of Convention No. 121, a
  ratifying state shall, as a minimum, recognise
  the occupational origin of all the diseases
  comprised in this list.

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History and development

• Amendment of the list of occupational diseases
• Article 31 of the Convention No. 121
• The International Labour Conference may, at any
  session at which the matter is included in its
  agenda, adopt by a two thirds majority amendments
  to Schedule I to this Convention.

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History and development

• Schedule I. List of Occupational Diseases
• 1964 15 diseases
• (five new diseases beryllium, chrome,
  manganese, carbon bisulphide, nitro- and
  amido-toxic derivatives of benzene its
  homologues).

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ILO Procedure of Amendment

• In Jan 1980, a meeting of experts proposed an
  amended list
• Its report was submitted to the 66th Session of
  the International Labour Conference (1980), at
  which the list of occupational diseases appended
  to the Convention No. 121 was duly amended
• The 1980 amended list of occupational diseases
  contained 29 diseases

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The Role Impact of the ILO List

• Promotion of the inclusion of a range of
  internationally acknowledged occupational
  diseases in national lists
• Harmonization of the development of policy on
  occupational diseases and in promoting their
  prevention.
• Serving as an example for countries establishing
  or revising their national lists.

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The Role Impact of the ILO List

• Adding to the list would imply the extension of
  preventive measures to control the use of harmful
  substances and would assist a better health
  surveillance or workers.
• This effect can be expected both in countries
  that have ratified the Convention and those that
  have not.

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Why the List Needs to Be Regularly Updated?

• New risk factors
• Diagnostic technology
• New diseases
• Increased recognition at the national level
• International development

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• 90th Session of the International Labour
  Conference, June 2002, Geneva

Recommendation No. 194 Recommendation concerning
the List of Occupational Diseases and the
Recording and Notification of Occupational
Accidents and Diseases.
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R194 List of Occupational Diseases
Recommendation, 2002

• Paragraph 2
• A national list of occupational diseases
  should
• (a) for the purposes of prevention, recording,
  notification and compensation comprise, at the
  least, the diseases enumerated in Schedule I of
  the Employment Injury Benefits Convention, 1964,
  as amended in 1980
• (b) comprise, to the extent possible, other
  diseases contained in the list of occupational
  diseases as annexed to this Recommendation and
• (c) comprise, to the extent possible, a section
  entitled "Suspected occupational diseases".

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R194 List of Occupational Diseases
Recommendation, 2002

• Paragraph 3 states that
• The list as annexed to this Recommendation
  should be regularly reviewed and updated through
  tripartite meetings of experts convened by the
  Governing Body of the International Labour
  Office. Any new list so established shall be
  submitted to the Governing Body for its approval,
  and upon approval shall replace the preceding
  list and shall be communicated to the Members of
  the International Labour Organization.

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R194 List of Occupational Diseases
Recommendation, 2002

• Paragraph 4 states that
• The national list of occupational diseases
  should be reviewed and updated with due regard to
  the most up-to-date list established in
  accordance with Paragraph 3 above.

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R194 List of Occupational Diseases
Recommendation, 2002

• Paragraph 6 states that
• Each Member should furnish annually to the
  International Labour Office comprehensive
  statistics on occupational accidents and diseases
  and, as appropriate, dangerous occurrences and
  commuting accidents with a view to facilitating
  the international exchange and comparison of
  these statistics .

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R194 List of Occupational Diseases
Recommendation, 2002

• http//www.ilo.org/public/english/standards/relm/i
  lc/ilc90/pdf/rec-194.pdf.

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European Schedule of Occupational Diseases

• Annex I concerns diseases which are occupational
  in origin.
• Annexed II concerns diseases suspected of being
  occupational in origin which should subject to
  notification and which may be considered at a
  later stage for inclusion in Annex I of the
  European Schedule.

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European Schedule of Occupational Diseases

• Diseases due to chemical agents
• Skin diseases due to other substances and agents
• Diseases due to inhalation of substances and
  agents not included under other sections
• Infectious and parasitic diseases
• Diseases caused by physical agents

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Updating the List of Occupational Diseases
Annexed to R194, 2002

• ILO GB Decision in Nov. 2004
• Technical preparation
• Tripartite Meeting of Experts to be held in
  December 2005

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Technical preparation

• Analysis of national lists
• International development
• Questionnaires to ILO 178 member States

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Technical preparation

• The list will not include all known occupational
  diseases
• Diseases on the list should be common to a number
  of countries or populations.
• Rare disorders ( or less frequent and very
  specific to a small target group) can be dealt
  with at a local level.

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Technical preparation

• No change to the current format of the list
• diseases caused by agents (chemical, physical,
  biological)
• diseases of target organ systems (respiratory,
  skin, musculoskeletal)
• occupational cancer.

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Technical preparation

• Efforts will be made to avoid ambiguity that
  would result from double entry of either agents
  or conditions.
• Where agents result in multiple organ system
  diseases, these should be included within the
  list of agents.
• The agents will be classified as noted with the
  indication that only non-cancer end points are
  considered.

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Technical preparation

• Carcinogens are listed separate for emphasis and
  because of their importance.
• The inclusion of the IARC category 1 list was
  noted to be a minimum inclusion with possibility
  of inclusion of the other substances within the
  carcinogen listing which are not on the IARC
  category 1 list.

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Technical preparation

• The general titles for each section will be kept.
• These general titles for each section allow the
  addition of new diseases into the list and make
  the list open.
• This would permit in the future to avoid too
  frequent revisions of the list by having a
  continuous process of recognizing confirmed
  occupational diseases based on new scientific,
  epidemiological and statistical information and
  evidence.

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Technical preparation

• Agents/Diseases to be considered for inclusion in
  the new list
• Chemicals (pesticides?)
• Physical (EMF?)
• Biological (Tetanus ,Brucellosis HBV/HCV, TB,
  HIV?)
• Diseases by target organs (Mental and behavioural
  illnesses such as Post-Traumatic Stress Disorder
  due to stressful event or situation and
  Psychosomatic and Psychiatric Syndrome caused by
  mobbing, MSDs?)
• Occupational Cancer (Arsenic , Beryllium ,
  Cadmium , Erionite , Ethylene oxides , Silica ,
  Hepatitis B Virus and C Virus ?)

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Tripartite Meeting of Experts on the Updating of
the List of Occupational Diseases, Geneva,
December 2005
The experts will be invited taking into account

• the technical specialities to be covered
  according to the types of diseases
• the general experience on the policy of
  occupational diseases in each of the
  participants country
• Geographic balance
• association with governments, employers
  organizations and trade unions.

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Tripartite Meeting of Experts on the Updating of
the List of Occupational Diseases, Geneva,
December 2005

• The importance of having an adequate scientific
  basis for discussion will be the basis for the
  work of the experts.
• No comprehensive criteria document will be
  prepared for the proposed new additions to the
  list.
• The new list will reflect the best scientific
  judgement of the experts presented.

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Tripartite Meeting of Experts on the Updating of
the List of Occupational Diseases, Geneva,
December 2005
Key criteria for updating the ILO list may
include

• the strength of exposure and effect relationship,
  
• the magnitude of the risk factors and
• the fact that a disease is recognized in many
  national lists.

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• Thank you!
• Dr. Shengli Niu
• ILO/SafeWork